Successful Orthognathic Surgery Billing

Introduction

Orthognathic surgery is a transformative procedure for patients, often addressing severe functional and aesthetic issues. However, navigating the complexities of insurance billing for these surgeries can be a significant challenge for providers. Successfully handling the intricacies of medical insurance is essential to maximizing reimbursement. By mastering the use of dental codes vs. medical codes, practices can increase reimbursement rates by up to 50% while reducing administrative burdens. Discover how AllStar Billing can help your practice streamline the billing process and achieve greater financial success.

Why Orthognathic Surgery Billing Is Challenging

Orthognathic surgery often involves multiple facets that straddle the line between medical necessity and being deemed cosmetic in nature. Providers face unique challenges, including:

• Frequent authorization denials due to questions about medical necessity and not meeting insurance criteria.
• Difficulty determining when to use medical versus dental codes.
• Time-consuming administrative tasks such as submitting authorizations, setting up peer to peers and responding to denials.

These challenges can delay treatment for patients, payments, reduce reimbursements, and overwhelm in-house teams. That’s where AllStar Billing comes in.

How All Star Billing Solves These Challenges

1. Comprehensive Pre-Authorization Services

We simplify the pre-authorization process by working directly with insurance providers to ensure that the medical necessity of each procedure is clearly established upfront. This proactive approach significantly reduces the risk of denials.

2. Expert Use of Dental vs. Medical Codes

Our billing experts understand when to use dental codes and when medical codes are more appropriate. By strategically coding procedures, we help practices unlock the maximum reimbursement potential. For example:

• Some insurance companies accept dental codes for orthognathic surgery
• We understand when dental codes will be denied and medical codes must be used.

This targeted approach can increase reimbursement rates by up to 50%, making a significant impact on your bottom line.

3. Accurate Documentation

Insurance companies require thorough and precise documentation to approve claims. Our team ensures that every authorization and claim includes the correct ICD-10, CPT, or CDT code, along with comprehensive supporting documentation. This minimizes delays and increases approval rates.

4. Streamlined Submission and Follow-Up

We handle the entire submission process, freeing up your in-house staff to focus on patient care. From authorizations, initial claims to follow-ups, our team ensures a smooth and efficient process, leading to faster payments and fewer headaches.

Tips for Practices Handling Billing In-House

For offices that wish to manage orthognathic surgery billing on their own, here are actionable tips to improve your process and maximize reimbursements:

1. Invest in Training: Ensure your billing team is well-versed in both dental and medical coding. Understanding which code to use based on the procedure’s purpose can significantly affect reimbursement rates.
2. Develop a Pre-Authorization Checklist: Create a standardized checklist to streamline the pre-authorization process. Include all necessary documentation, such as diagnostic reports and evidence of medical necessity.
3. Stay Updated on Insurance Policies: Regularly review changes in insurance coding and billing requirements. This helps avoid using outdated codes or procedures that insurers may deny.
4. Utilize Billing Software: Invest in robust billing software that integrates medical and dental coding. Automated tools can reduce human error and improve efficiency.
5. Track and Analyze Denials: Keep a record of denied claims to identify patterns and address recurring issues. Use this information to improve your billing and documentation practices.
6. Establish Clear Documentation Protocols: Make it a standard practice to thoroughly document every procedure, including photos, X-rays, and detailed notes that justify the medical necessity.
7. Maintain Open Communication with Insurers: Build relationships with insurance providers to clarify requirements and resolve issues more efficiently.
8. Set Aside Time for Appeals: Allocate dedicated time and resources to address claim denials and follow up on appeals.

The Benefits of Partnering with AllStar Billing

• Increased Revenue: Maximize reimbursements with strategic coding and expert claim management.
• Reduced Administrative Burden: Free your in-house team from time-consuming billing tasks.
• Faster Payments: Expedite claim approvals with accurate coding and documentation.
• Fewer Denials: Improve success rates with pre-authorization and comprehensive documentation.

Why Choose All Star Billing?

AllStar Billing specializes in the unique demands of orthognathic surgery billing. Our expertise ensures that your practice gets paid faster and more efficiently. By partnering with us, you can focus on what matters most: delivering exceptional care to your patients.

Unlock the Full Potential of Your Reimbursements

Orthognathic surgery billing doesn’t have to be a hassle. With AllStar Billing, you can:

• Increase reimbursement rates by up to 50%.
• Minimize claim denials and delays.
• Reduce administrative stress for your team.

Let us handle the complexities of insurance billing while you concentrate on transforming patients’ lives. Contact AllStar Billing today to learn more and take the first step toward greater financial success for your practice, so you can continue doing the cases you love.

FAQs

1. Why is understanding dental and medical codes important for orthognathic surgery billing? Proper use of these codes can significantly increase reimbursement rates and reduce claim denials.
2. When do you use dental vs medical codes in orthognathic cases? This is insurance plan driven. Many insurance plans will accept dental codes for some orthognathic procedures. You will need to research your patients plan to see if they accept the dental code.
3. How can pre-authorization help reduce claim denials? Pre-authorization ensures that insurance providers recognize the medical necessity of a procedure before it is performed.
4. Can outsourcing billing really make a difference? Yes, outsourcing to experts like AllStar Billing streamlines the process, reduces in-house workload, and improves reimbursement success rates. Outsourcing eliminates your trial and error of coding and requirements of each insurance company.
5. How does accurate documentation impact insurance claims? Detailed documentation validates the necessity of a procedure, making it more likely for the claim to be approved quickly and without issues.